GI Flashcards
(229 cards)
0
Q
sternal defect
A
rostral fold closure
1
Q
Trypsinogen is secreted by? Converted by?
A
Pancreas
Enterokinase
Enteropeptidase
Secreted from duodenum
2
Q
omphalocele
A
lateral fold closure
3
Q
gastrochisis
A
lateral fold clsure
4
Q
bladder exstrophy
A
caudal fold closure
5
Q
Duodenal atresia
A
failure to recanalize,
trisomy 21
6
Q
Jejunal, ileal, colonic atresia
A
vascular accident
apple peel atresia
7
Q
mid gut develop in ? week
A
6th week nerniate through umbilical ring
10th week return to abdominal cavity=rotates around SMA
8
Q
foregut give rise to?
A
pharynx to duodenum
9
Q
mid gut give rise to?
A
duodenum to transverse colon
10
Q
hind gut give rise to?
A
dital transverse colon to rectum
11
Q
extrusion of abdominal contents through abdominal folds
not covered by peritonuem
A
gastroschisis
protrude through umbilicus
12
Q
persistence of herniation of abdominal contens into umbilical cord
covered by peritoneum
A
omphanlocele
13
Q
tracheoesophageal anomalies
A
esophageal atresia with distal tracheoesophageal fistula is most common
14
Q
vomiting with first feeding
CXR with air in the stomach
A
EA with distal TEF
failure fusion of tracheoesophageal fold
cyanosis 2ndary to laryngospasm, avoid reflux-related aspiration
15
Q
Vomiting: 2-4wk, palpable olive mass in epigastric region and nonbilious projectile vomiting
A
pyloric stenosis
treat with surgery
16
Q
vomiting with first feeding
CXR with no air in the stomach
A
pure atresia EA the CXR shows gasless abdomen
17
Q
turn blue when they are fed and pink when they cry
A
membrane that connect phargnx do not dissolve
choanale:space between nostril & phargnx block
choanal atresia: breath through mouth
18
Q
vomit in the 1st day of life
A
duodenal atresia trisomy 21 polyhydramnios treat: surgery CXR: double bubble, stomach& duodenum
19
Q
pancreas derived from?
A
foregut
20
Q
ventral buds of pancreas contributes?
A
pancreatic head and main pancreatic duct
21
Q
dorsal pancreatic bud
A
everything else: body, tail, isthmus, and accessory pancreatic duct
22
Q
Annular pancreas
A
ventral pancreatic bud abnormally encircles 2nd part of duodenum
narrowing
23
Q
pancreas divisum
A
ventral and dorsal fail to fuse at 8th week
24
spleen arises from?
mesentery of stomach, mesoderm
| supplied by forgut: celiac artery
25
Pancreas secrets?
```
secretin stimulates HCO3- secretion
influx: HCO3 and K
efflux:Na and Cl
cephalic: via vagal efferents
Gastric: distension + via vagovagal reflex
```
26
retroperitoneal organs?
| covered by parital peritonum
pancreas
lower esophagus, duodenum, descend and ascend colon, rectum
kidney, suprarenal glands,ureters
aorta and IVC
27
falciform ligament
connects?
contain?
liver to anterior abdomin
ligementum teres hepatis
from unbilical vein
28
hepatoduodenal ligament
connects?
contain?
```
liver to duodenum
portal triad: hepatic artery
portal vein
common bile duct
pringle maneuver, connect greater and lesser sacs
```
29
gastrohepatic ligament
connects?
contain?
liver to lesser curvature of stomach
gastric arteries
separate greater and lesser sacs on the right, may be cut to access lesser sac
30
Gastrocolic ligament
connects?
contain?
Greater curvature and transverse colon
Gastroepiploic arteries
part os greater omentum
31
gastrosplenic ligament
connects?
contain?
greater curvature and spleen
short gastrics
left gatroepiploic vessels
separates greater and lesser sacs on the left
32
splenrenal ligament
connects?
contain?
spleen to posterior abdominal wall
| splenic artery and vein, tails of pancreas
33
layers of gut wall?
```
MSMS
Mucosa
Submucosa: Meissner's
Muscularis: Auerbach's
Serosa/adventitia(retroperitoneal)
```
34
DD of ulcer and erosion
ulcer: submucosa
erosion: only mucosa
35
freq of rhythm?
stomach?
duodenum
ileum?
3
12
8-9
36
PANS vs SANS on motility of bowel?
PANS contraction and increase secretion
SANS relaxation and increase secretion
VIP relaxation and increase secretion
substance P: contraction and increase secretion
Neuropeptide Y: relax muscle and decrease secretion
Enkephalin: contraction and decrease secretion
37
peyer's patch appears in?
Ileum
38
Plicae circulares appears in?
Jejunum
| Ileum
39
crypts of lieberkuhn appears in?
Duodenum
Jejunum
Ileum
all small bowel
40
brunner's gland appears in?
duodenum
41
crypts with no villi
| with goblet cells
colon
42
esophagus smooth muscle in? skeleton muscle in?
lower 1/3,involuntary,normally stricted, ACh increase tone and NO, VIP relaxes
upper1/3, voluntary, innervated by X,
43
superior mesenteric artery syndrome
transverse portion,3rd segment of the duodenum is entrapped between SMA and aorta
intestional obstruction
44
transverse colon blood supply
proximal 2/3 is SMA
| distal 1/3 is IMA
45
gut PANs innervation and vertebral level
vagus for fore and mid
| pelvic for hindgut
46
which of the gastric artery have poor anastomosis?
short gastric
| if splenic is blocked
47
portosystemic anastomoses
esophagus:left gastric esophagus
umbilicus: paraumbilical superficial&inferior epigastric below umbili
superior epigastric and lateral thoracic above the umbilicus
rectum: superior middle and inferior rectal
48
CA of rectum? above D and below D
above D: adenocarcinoma
| below D: squamous cell carcinoma
49
arterial supply above and below D in rectum?
above: IMA
below: inferior rectal artery from internal pudenal artery
50
Vein drainage of rectum above and below D
above: superior retal vein--> inferior mesenteric vein--> portal vein
below: middle and inferior vein-->internal pudendal vein-->internal iliac vein->IVC
51
innervation of rectum above and below D
above: visceral innervation
below: somatic innervation(inferior rectal branch of pudendal nerve)
52
lymphatic drainage above and below D
above: deep node
below: superficial inguinal nodes
53
hepatic zones?
zone1: periportal zone, 1st blood flow, last bile
zone2: intermediate zone
zone3:pericentral vein,last blood flow, ischemia, 1st bile
zone 3 also contain p450, sensitive to toxic, alcohol hepatitis
54
Ito cell
| stellate cell is?
mesenchymal cells, space of disse
| fat and involved instorage of fat-soluble vitamins, Vit A
55
ampulla of Vater
gallstone here can block both bil and pancreatic duct
56
femoral sheath contain?
VA and canal with deep inguinal LN
| but NOT N
57
femoral triangle contains
VAN
58
sliding hiatal hernia
GE junction is displaced向上，
hourglass
associated with GERD
59
paraesophageal hernia
GE junction is normal
Fundus protrudes into the thorax
Painful
60
hernia medial to inferior epigastric vein
| Hessel bach's triangle
Direct hernia
61
hernia lateral to inferior epigastric artery
indirect hernia
62
hernia medial to femoral vein?
femoral hernia
63
hernia that go through the internal and external inguinal ring
indirect hernia
64
hernia that go through only the external inguinal ring
direct hernia
covered only by external spermatic fascia
in older man
65
femoral triangle
medially: lacunar ligament
anterior: inguinal ligament
posterior: pubis
laterally: femoral vein
66
Hessel bach's triangle
inferior epigastric vessels
lateral border of rectus abdominis
inguinal ligament
67
Gastrin
source?
action?
regulate?
G cells,antrum of stomach
increase H, increase gastric mucosa growth, increase motility
increase by distension, AA, vagal stimulation,
decrease by pH<1.5
68
Cholecystokinin
source?
action?
regulate?
1. I cells, duodenum, jejunum
2. increase pancreatic secretion, gallbladder contract,sphincter of Oddi relaxation; decrease gastric emptying
3. increase by FA, AA
69
Secretin
source?
action?
regulate?
1. S cells, duodenum
2. increase pancreatic HCO3 secretion, bile secretion, decrease gastric acid secretion
3. increase acid, FA in lumen of duodenum
70
Somatostatin
source?
action?
regulate?
1. D cells, pancreatic islets, GI mucosa
2. decrease gastric acid and pepsinogen secretion, pancreatic and small intestine fluid secretion, gallbladder contraction, insulin & Glucagon release.DECREASE EVERYTHING
3. increase acid and decrease vagal stimulation
71
glucose-dependent insulinotropic peptide
source?
action?
regulate?
1. K cells, duodenum, jejunum
2. Exocrine: decrease gastric H secretion;
Endocrine: increase insulin release
3. increase FA, AA, oral glucose.
72
Vasoactive intestinal polypeptide (VIP)
source?
action?
regulate?
1. PANS in sphincters, gallbladder, small intestine
2. increase intestinal water and electrolyte secretion, relax of intestinal smooth muscle and sphincter
3.increase by distention and vagal stimulation
decrease by adrenergic input
73
NO
source?
action?
regulate?
1.
2. increase smooth muscle relaxation, including lower esophageal sphincter
3.
74
Motilin
source?
action?
regulate?
1. small intestine
2. produced migrating motor complexes,MMC
3. increase in fasting state.
75
intrinsic factor
source?
action?
regulate?
1. parietal cells, stomach
2. Vit B12-binding protein, needed for uptake in the ileum
3.
76
Gastric acid
source?
action?
regulate?
1. parietal cells, stomach
2. decrease pH
3. increase by histamin, ACh, gastrin
decrease by somatostatin, GIP, prostaglandin, secretin
77
Pepsin
source?
action?
regulate?
1. Chief cells, stomach
2. Protein digestion
3. increase by vagal stimulation, local acid
78
HCO3
source?
action?
regulate?
1.mucosa cells, stomache,duodenum,salivary gland, pancreas
Brunner gland, duodenum
2.neutralizes acid
3. increase pancreatic and biliary secretion with secretin.
79
saliva electrolyte regulation
```
reabsorb Na and Cl
secrete K and HCO3
impermeable to water
regulated by PANS(change flow) and aldosterone(do not change flow)
SANS,紧张的时候口干
```
80
secretion of different saliva gland？innervation?
parotid：serous, VII
submandibular：mix, IX
sublingual：mix，predominant mucous,IX
81
protection mucosal barrier in stomach
mucus
gastrin
prostaglandin
GH
82
DM patients are more likely for bloating beacuse?
decrease ACh
83
最快排空的是什么物质
等渗盐水
| acid, fat and osm increase all decrease motility
84
Brunner's glands
Located in duodenal submucosa
secrete alkaline mucus
hypertrophy seen in peptic ulcer disease
85
pancreatic secretion associated with flow?
low flow: high Cl-
high flow: high HCO3-
Isotonic fluid
86
Glucose uptake by?
SGLT1
Na dependent
transported to blood by GLUT-2
87
Galactose
SGLT1
Na dependent
transported to blood by GLUT-2
88
Fructose is uptake by?
facilitated diffusion by GLUT-5
| transported to blood by Glut-2
89
D-xylose absorption test
distinguishes GI mucosal damage from other causes of malabsorption
90
Iron is absorbed in?
duodenum as Fe2+
| also with Mg,Ca, Vit
91
Folate is absorbed in?
jejunum
92
B12 is absorbed in?
TI along with bile acid, requires intrinsic factor
93
Peyer's patches
unencapsulated lymphoid tissue in lamina propria and submucosa of ileum
contain specialized M cell that take up Ag
B cell stimulated in germinal centers of peyer's patches differentiate into Ig A secreting plasma cells
94
bile acid conjugated to?
glycine, taurine
| making them water soluble
95
bile compose of?
```
bile salt
phospholipid
chol
bilirubin
water and ion
```
96
What is the rate limiting step of bile synthesis
Chol 7alpha-hydroxylase
97
Gallbladder is lined by?
simple columnar epi that absorb secretion of mucus
lack muscularis mucosa
**two way valve
98
unconjugated bile is conjugated with?
glucuronate and become direct bilirubin that is water soluble
99
Pleomorphic adenoma
```
benign mixed tumor
most common salivary gland tumor
painless mobile mass
composed of cartilage and epi
recurs freq
```
100
Warthin's tumor
papillary cystadenoma lymphomatosum
benign cystic tumor with germinal centers
lymphoid stroma
101
Mucoepidermoid carcinoma
most common malignant tumor and has mucinous and squamous components
presents as painful mass because of common involvement of the facial nerve
102
Acinic cell tumor
cell resembling the serous cells of the salivary gland
103
Leukoplakia
white plaque on the oral mucosa for which a more specific diagnosis cannot be rendered,
hyperkeratosis 5% have in situ or carcinoma
from smoking pipe or tobacco
cannot be scraped off
104
Achalasia
relaxation of lower esophageal sphincter due to loss of myenteric(Auerbach's) plexus.
high LES opening pressure and incoordinated peristalisis-> progressive dysphagia to solids and liquids
increase risk for esophageal squamous cell carcinoma
105
GERD
```
heartburn
regurgitation upon lying down
nocturnal cough and dypnea
adult onset asthma
decrease LES tone
```
106
Esophageal varices
plainless bleeding of dilated submucosal veins in lower 1/3 of esophagus, 2nd to portal hypertension
107
Esophagitis
```
reflux infection
candida:white pseudomembrane
HSV-1:punched-out ulcers
CMV:linear ulcers
chemical ingestion
```
108
Mallory-Weiss syndrome
mucosal laceration at the gastroesophageal junction due to severe vomiting.
Lead to hematemesis
found in alcoholoc and bulimics
109
BoerHaave syndrome
transmural esophagus rupture de to violent vomitperforation will result in L pneumothorax and left pleural effusion
trachea to the right and esophagus to the left
110
hamman's sign
subcutaneous emphysema
111
Plummer-Vinson syndrome
I love GD
Iron deficiency
glossitis
dysphagia
112
cockscrew esophagus
diffuse esophageal spasm
| periodic, non-peristaltic contraction of esophagus
113
Barrett's esophagus
glandular metaplasia
replacement of nonkeratinized squamous epi with nonciliated colmnar
chronic acid reflux
114
CA in upper 2/3 of esophagus
```
squamous cell
Alcohol
Cigarett
Diverticula
Esophageal web
Hot liquid
```
115
CA in lower1/3 of esophagus
```
afenocarcinoma
Barrett's esophagus
Cigaretts
Fat
GERD
```
116
Aphthous ulcer
canker sore
| stress
117
Oral Thrush
can be scraped off
118
sialadenitis
occurs in old ppl
using phenothiazine
dry mouth and dehydration->stone formation ->block passage -> inflammation
119
reactive nodules
vocal cord polyp
heavy smoker
strain vocal--singer
120
odontogenic keratocyst
odentogenic epi in Jaw
| can recurr
121
Tropical sprue
Similar findings as celiac sprue (affects small bowel)
responds to antibiotics.
Cause is unknown, but seen in tropics.
abnormal flattening of the villi and inflammation of the lining of the small intestine
122
Whipple disease
Infection with Tropheryma whipplei (gram positive);
PAS foamy macrophages in intestinal lamina propria, mesenteric nodes.
Cardiac symptoms, Arthralgias, and Neurologic symptoms.
Most often occurs in older men.
123
Celiac sprue(celiac disease)
Autoimmune-mediated intolerance of gliadin (wheat)
HLA-DQ2, HLA-DQ8, and northern European descent.
Findings: anti-endomysial, anti-tissue transglutaminase(diagnosis), and anti-gliadin antibodies;
blunting of villi; and lymphocytes in the lamina propria in distal duodenum and/or proximal jejunum. (B12 deficiency,iron deficiency)
Associated with dermatitis herpetiformis, T-cell lymphoma
Treatment: gluten free diet.
124
Disaccharidase deficiency
Most common is lactase deficiency->milk intolerance.
Normal-appearing villi.
Osmotic diarrhea.
lactase is located at tips of intestinal villi, self-limited lactase deficiency can occur following injury (e.g., viral diarrhea).
125
Abetalipoproteinemia
decreased synthesis of apolipoprotein B
inability to generate chylomicrons-->secretion of cholesterol, VLDL into bloodstream -->fat accumulation in enterocytes.
present early in childhood with malabsorption and neurologic
126
Pancreatic insufficiency
```
Due to cystic fibrosis
obstructing cancer,
chronic pancreatitis.
Causes malabsorption of fat and fat-soluble vitamins (vitA, D, E, K).
neutral fat in stool
```
127
stool analysis
48hr controlled disease
stool to identify fat
quantative fat
diagnosis
128
dumping syndrome
food emptying too fast
| Nausea, cramping, diarrhea, palpitation and sweating , faintness
129
Acute gastritis
Disruption of mucosal barrier-> inflammation.
Can be caused by stress, NSAIDs (decreased PGE2-> decreased gastric mucosa protection), alcohol, uremia, burns (Curling ulcer -plasma volume->sloughing of gastric mucosa), and brain injury (Cushing ulcer— vagal->stimulation-> increased ACh-> increased H+ production).
130
Curling ulcer .
-Decrease plasma volume->sloughing of gastric mucosa
| from burns
131
Cushing ulcer
brain injury (vagal->stimulation-> increased ACh-> increased H+ production)
132
Chronic gastritis(nonerosive):Type A (fundus/body) AB
Autoantibodies to parietal cells, pernicious Anemia, and Achlorhydria. Associated with other autoimmune disorders.
133
```
Chronic gastritis(nonerosive): Type B (antrum)
BA
```
Most common type.
Caused by H. pylori infection. (urease+)
increased risk of MALT lymphoma and gastric adenocarcinoma
Malt Adeno Pylori-->MAP
134
Ménétrier disease
Gastric hypertrophy with protein loss, parietal cell atrophy(H and intrinsic factor), and increase mucous cells.
Precancerous.
Rugae of stomach are so hypertrophied that they look like brain gyri.
135
Stomach cancer
Almost adenocarcinoma. Early aggressive local spread and node/liver metastases.
Often presents with acanthuses nigricans.
Intestinal&Diffuse
DCC, tumor suppressing gene, 18q, also seen in pancreatic cancer
136
Intestinal stomach cancer
associated with H. pylori infection, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydria, chronic gastritis.
Commonly on lesser curvature;
looks like ulcer with raised margins.
丑女，曲线小，还有ulcer，吸烟，吃熏肉，得细菌感染
137
Diffuse—
not associated with H. pylori;
signet ring cells
stomach wall grossly thickened and leathery (linitis plastica).
138
Krukenberg tumor
bilateral metastases to ovaries. Abundant mucus,signet ring cells. .
139
Virchow node
involvement of left supraclavicular node by metastasis from stomach.
140
Sister Mary Joseph nodule—
subcutaneous periumbilical metastasis of stomach CA
141
Peptic ulcer disease: Gastric ulcer
```
pain greater with meals-weight loss.
H.pylori infection: in 70%.
decreased mucosal protection against gastric acid. NSAIDs.
risk of carcinoma: increased.
older patients.
```
142
Peptic ulcer disease: duodenal ulcer
pain: decreases with meals-weight gain.
H.pylori infection: in almost 100%.
mechanism: decrease mucosal protection or increase gastric acid secretion. other causes: Zollinger-ellison syndrome.
hypertrophy of brunner glands(secretes alkaline mucus).
anterior and 1st part ulcer may perforate into pancreas
143
zollinger-Ellison syndromee
increase gastric acid secreting cell, parital cell(rugal thickening)
hypertrophic mucosa
duodenal ulcer, distal duodenum in weird places
pancreatic lipase inactivation-->steatorrhea
MEN1
Tx:receptor block H pump
Diagnosis:administer secretin for diagcosis, gastrin not inhibited
144
MALT lymphoma
H. pylori infection
B-cell malignancy
mucosa-associated lymphoid tissue-lymphoid follicles in stomach wall
145
Ulcer complications: Hemorrhage
Gastric, duodenal (posterior > anterior). Ruptured gastric ulcer on the lesser curvature of the stomach-> bleeding from left gastric artery. An ulcer on the posterior wall of the duodenum bleeding from gastroduodenal artery.
146
Ulcer complications:Perforation
Duodenal (anterior > posterior).
| May see free air under the diaphragm with referred pain to the shoulder.
147
Inflammatory bowel diseases: Crohn disease
Disordered response to intestinal bacteria.
usually the terminal ileum and colon. Skip lesions, rectal sparing.
Transmural inflammation fistulas. Cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures.
Noncaseating granulomas and lymphoid aggregates (Th1 mediated). Diarrhea that may or may not be bloody. stricure, fistula, AS, kidney stone, erythema nodosum
148
string sign" on barium swallow x-ray
bowel wall thickening
149
Inflammatory bowel diseases: Ulcerative colitis
etiology, location, gross, micro
complication and manifectation
Autoimmune.
Continuous colonic lesions, always with rectal involvement.
mucosal and submucosal inflammation only
loss of haustra: lead pipe on imaging
crypt abcess and ulcers, no granulomas, Th2 mediated
Bloody diarrhea, sclerosing cholangitis, toxic megacolon,CA
pyoderma gangrenosum, PSC, AS
150
Irritable bowel syndrome
Recurrent abdominal pain associated with ≥ 2 of the following:
Pain improves with defecation.
Change in stool frequency.
Change in appearance of stool.
No structural abnormalities. Most common in middle-aged women. Chronic symptoms. diarrhea, constipation, or alternating symptoms.
151
Appendicitis
Acute inflammation of the appendix due to obstruction by fecalith (in adults) or lymphoid hyperplasia (in children).
Initial diffuse periumbilical pain migrates to McBurney point (1 ⁄3 the distance from anterior superior iliac spine to umbilicus).
Nausea, fever; may perforate leads to peritonitis; may see psoas, obturator, and Rovsing signs.
152
Diverticulum
Blind pouch protruding from the alimentary tract that communicates with the lumen of the gut.
Most diverticula (esophagus, stomach, duodenum, colon) are acquired and are termed "false" in that they lack or have an attenuated muscularis externa.
Most often in sigmoid colon.
153
Diverticulosis
Many false diverticula of the colon, commonly sigmoid.
Common (in ~50% of people > 60 years).
Caused by increased intraluminal pressure and focal weakness in colonic wall.
Associated with low-fiber diets.
154
Diverticulitis
Inflammation of diverticula classically causing LLQ pain, fever, leukocytosis. May perforate increased peritonitis, abscess formation, or bowel stenosis.
Give antibiotics.
Stool occult blood is common +/- hematochezia. May also cause colovesical fistula (fistula with bladder) increased pneumaturia. Sometimes called "left-sided appendicitis" due to overlapping clinical presentation.
155
Zenker diverticulum
Pharyngoesophageal false diverticulum.
Herniation of mucosal tissue at Killian triangle between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor.
dysphagia, obstruction, foul breath (halitosis).
Most common in elderly males.
156
Herniation of mucosal tissue at Killian triangle
Zenker diverticulum
157
Meckel diverticulum
True diverticulum. Persistence of the vitelline duct.
May contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue.
melena, RLQ pain, intussusception, volvulus, or obstruction near the terminal ileum.
Diagnosis: pertechnetate study for uptake by ectopic gastric mucosa.
158
omphalomesenteric cyst
cystic dilation of vitelline duct
159
Intussusception
commonly at ileocecal junction.
Compromised blood supply, abdominal pain, currant jelly stools. Unusual in adults (associated with intraluminal mass or tumor)
Majority of cases occur in children (usually idiopathic; may be associated with recent enteric or respiratory viral infection).
Abdominal emergency in early childhood
160
Volvulus
Twisting of portion of bowel around its mesentery;
can lead to obstruction and infarction.
Can occur throughout the GI tract.
cecum and ascending colon more common in infants and children.
Sigmoid volvulus more common in elderly.
161
Hirschsprung disease
Congenital megacolon:lack of ganglion cells/enteric nervous plexuses (Auerbach and Meissner plexuses) in segment on intestinal biopsy.
Due to failure of neural crest cell migration. mutations in the RET gene.
Presents: bilious emesis, abdominal distention, and failure to pass meconium in the first 48 hours-->chronic constipation.
Dilated portion of the colon proximal to the aganglionic segment, resulting in a "transition zone." Involves rectum.
162
Duodenal atresia
Causes early bilious vomiting with proximal stomach distention ("double bubble" on X-ray) because of failure of small bowel recanalization.
Associated with Down syndrome.
163
Adhesion
Fibrous band of scar tissue;
commonly forms after surgery;
most common cause of small bowel obstruction.
Can have well-demarcated necrotic zones
164
Angiodysplasia
Tortuous dilation of vessels leads to hematochezia.
Most often found in cecum, terminal ileum, and ascending colon.
More common in older patients.
Confirmed by angiography
165
Ischemic colitis
Reduction in intestinal blood flow causes ischemia.
Pain after eating -> weight loss.
Commonly occurs at splenic flexure and distal colon.
Typically affects elderly.
166
Necrotizing
| enterocolitis
Necrosis of intestinal mucosa and possible perforation.
Colon is usually involved, but can involve entire GI tract.
In neonates, more common in preemies ( decreased immunity).
167
Colonic polyps
colonic polyps: Masses protruding into gut lumen->sawtooth appearance.
90% are non-neoplastic.
Often rectosigmoid.
Can be tubular or villous.
168
Adenomatous polyps
Precursor to colorectal cancer (CRC).
Malignant risk is associated with increased size, villous histology, increase epithelial dysplasia.
The more villous the polyp, the more likely it is to be malignant (villous = villainous).
Polyp symptoms—often asymptomatic, lower GI bleed, partial obstruction, secretory diarrhea (villous adenomas)
169
Colonic polyps: Hyperplastic
Most common non-neoplastic polyp in colon (> 50% found in rectosigmoid colon
170
Colonic polyps: Juvenile
Mostly sporadic lesions in children < 5 years old. 80% in rectum.
If single, no malignant potential.
Juvenile polyposis syndrome—multiple juvenile polyps in GI tract, increased risk of adenocarcinoma.
171
Colonic polyps: Hamartomatous
| Peutz-Jeghers syndrome
AD, featuring multiple nonmalignant hamartomas throughout GI tract,
hyperpigmented mouth, lips, hands, genitalia.
increased risk of CRC and other visceral malignancies.
172
Gardener's syndrome
FAP+ osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium
173
Turcot's syndrome
FAP+ malignant CNS tumor
174
Hereditary nonpolyposis colorectal cancer
HNPCC
Lynch syndrome
AD
mutation of DNA mismatch repair gene
80% progress to CRC
proximal colon is always involved
175
CRC in different bowel section
ascending: exophytic mass, iron deficiency, anemia, weight loss
Descending: infiltrating mass, partial obstruction, colicky pain, hematochezia
176
Apple core on barium enema x-ray
CRC
177
tumor marker for CRC
CEA
178
Molecular
| pathogenesis of CRC
There are 2 molecular pathways that lead to CRC: Microsatellite instability pathway (~15%): DNA mismatch repair gene mutations ->sporadic and HNPCC syndrome.
Mutations accumulate, but no defined morphologic correlates.
APC/β-catenin (chromosomal instability) pathway (∼85%) sporadic
Normal-APC-->colon at risk-K-RAS-->adenoma-p53-->CA
179
Carcinoid tumor
small monotonous cells in Islands & trabeculae with stippled nuclei
tumor of neuroendocrine cells, secrete 5-HT
most common site appendix,ileum, and rectum
EM: dense core bodies, Dia; Chromogranin A(CgA)&5-HIAA
symptoms: wheezing, right heart murmur, diarrhea,flushing
metastasis outside GI is when the symptoms are observed
treat with resection, octreotide, somatostatin
180
cirrhosis->mental problem
decrease liver function(failure to meta waste material), increase Gut nitrogenabsorption
- ->increase ammonia in the blood
- ->enter the brain
- ->increase GABA
181
gynecomastia in cirrhosis
increase estrogen: failure to metabolize hormone by liver
- ->sex-hormone binding protein increase, bind androgen, androgen decrease
- ->gynecomastia+spider nevi
182
impaired biosynthesis capacity
increase PT
| decrease albumin
183
impair transport and metabolic
increase bilirubin
184
marker for liver injury
increase AST and ALT
185
marker of bile duct injury
increase Alka phosphate
| increase gamma-glutamyl transpeptidase
186
increase amylase
acute pancreatitis
| mumps
187
increase lipase
acute pancreatitis
188
increase ceruloplasmin
decrease in Wilson's disease
189
Reye's syndrome
rare, often fatal childhood hepatoencephalopathy
finding: mitochondrial abnormalities, fatty liver (microvesicular)
hypoglycemia, vomiting, hepatomegaly, coma
viral infection(VZV and influenza B)+aspirin: avoid aspirin in children
Mechan: aspirin metabolites decrease beta-oxidase by reversible inhibition of mitochondrial enzyme.
190
Hepatic steatosis
short-term change with moderate alcohol intake
| macrovesicular fatty change that may be reversible with alcohol cessation
191
Alcoholic hepatitis
```
requires sustained, long-term consumption
swollen and necrosis hepatocytes with neutrophilic infiltration
Mallory body (intracytoplasmic eosinophilic inclusion)
```
192
Alcoholic cirrhosis
final and irreversible form
micronodular, irregularly shrunken lover with hobnail appearance
sclerosis around central vein(zone III)
193
hep B
damage (proliferative phase):release Ag on the hepatocyte surface, conjunction with MHC I-->activate CD 8+ cell to destroy hepatocyte
integrative phase: HBV DNA is incorporated into host genome of hepatocyte survive the immune atack (turn in to CA)
194
Hep A
acute damage ->hepatocyte swelling (balloning)
- >mononuclear cell infiltration, councilman body
symptoms: fever dark urine, nausea& pain
195
hepatocellular carcinoma/hepatoma
most common primary malignant tumor of the liver adult
increase incidence is associated with hep B and C
Wilson's diseas, hemachromatosis, alpha1-antitrypsin deficiency
alcoholic cirrhosis and carcinogen (aflatoxin from aspergillus)
finding: jaundice, tender hepatomegaly, ascites, polycythemia, and hypoglycemia
196
cavernous hemangioma
common benign liver tumor
typically occurs 30-50yrs
biopsy contraindicated because of risk of hemorrhage
197
hepatic adenoma
benign lover tumor
often related to oral contraceptive or steroid use
can regress spontaneously
198
Angiosarcoma
Malignant tumor of endothelial origin
| associated with exposure to arsenic polyvinyl chloride
199
cholangiocarcinoma
collagen seposition associated with viral hepatitis
200
Nutmeg liver
Due to backup of blood into liver
commonly caused by right-sided heart failure and Budd-Chiari
liver appears mottled like a nutmeg.
if condition persist,centrilobular congestion and necrosis can result in cardiac cirrhosis
201
Budd-Chiari syndrome
occlusion of IVC or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver disease(hepatomegaly, ascites, abdominal pain>liver failure)--> develop varices and have visible abdominal and back vein, absence of JVD
associated with hypercoagulable state, polyeythemia, pregnancy, hepatocellular CA
202
alpha-antitrpsin deficiency
misfold gene product protein aggregates in hepatocellular ER-->
cirrhosis with PAS+ globules in liver-->
in lungs, lack of functioning enzyme-->decrease elastic-->
panaciner emphysema
Codominant trait
203
obstructive jaundice
increase direct bilirubin
increase urine bilirubin
decrease urine urobilinogen
204
hemolytic jaundice
increase indirect bilirubin
absent of urine bilirubin
increase urine urobilinogen
205
hepatocellular jaundice
increase both Direct and indirect
increase urine bilirubin
normal or decrease urobilinogen
206
physiologic neonatal jaundice
immature UDP-glucuronyl transferase->unconjugated hyperbilirubinemia>jaundice/fernicterus
treatment: phototherapy, converts UCB to water-soluble form
207
Gilbert's syndrome
decrease UPD-glucuronyl transferase or decrease bilirubin uptake
asymtomatic
elevated unconjugated bilirubin without overt hemolysis
bilirubin increases with fasting and stress
208
crigle-Najjar syndrome
| type 1
absent of UDP
jaundice, kernicterus early in life and die within a few yrs
increase unconjugated
treat:plasmapheresis and phototherapy
type II is less severe and responds to phenobarbital to increase liver enzyme
209
Dubin-Johnson syndrome
conjugated hyperbilirubinemia due to defective liver excretion
Grossly black liver
benign
210
Rotor's syndrome
similar to dubin johnson
| but milder and does not cause black liver
211
Wilson's disease
AR, chrom 13, ATP7B, increase ceruloplasm，kayser-Fleisher rings
hemolytic anmia
Basal ganglia degeneration-parkinson like(cystic degeneration)
Asterixis扑翼样震颤
Dementia, Dyskinesia, Dysarthria
treat with penicillamine
212
hemochromatosis
AR/transfusion related, deposition of iron
symptoms appear after 20g of Fe (men>40, women after menatration)
Cirrhosis, DM, skin pigmentation->bronze DM, CHF, testicular atrophy
increase risk of liver CA
increase ferritin, iron, decrease TIBC->increase transferrin saturation
C282Y/H63D mutation on HFE gene associated with HLA-A3
213
hemosiderous
hemolytic anemia, sickle cell anemia, blood tranfusion, thalassemia
coarse golden-brown granule with cytoplasm
Prussian blue staining of liver specimens shows + Iron deposition
214
pruritus, jaundice, dark unrine, light stool, hepatomegaly
increase conjugated bili, chol. alka phosph
increase pressure in intrahepatic ducts
2nd biliary cirrhosis
| caused by extrahepatic biliary obstruction, gall stone, CA-->increase pressure->injury and fibrosis
215
pruritus, jaundice, dark unrine, light stool, hepatomegaly
increase conjugated bili, chol. alka phosph
increase serum mitochondrial antibodies
primary biliary cirrhosis
autoimmune reation->lymphocytic infiltration+granuloma->destruction of duct;
Ab include IgM
associated with CREST, rheumatoid arthritis, celiac disease
216
pruritus, jaundice, dark unrine, light stool, hepatomegaly
increase conjugated bili, chol. alka phosph
beading of intra-extra hepatic bile duct
```
Primary sclerosing cholangitis
onion skin bile duct fibrosis->alternating stricture and dilation with beading on ERCP
hypergammaglobulinemia(IgM)
associated with UC
lead to 2nd biliary cirrhosis
```
217
chol stone
radiolucent with 10-20% opaque due to clacification
| obesity, CD, cystic fibrosis, advanced age, clofibrate, estrogen, multiparity, rapid weight loss and Native American
218
pigmented stone
radiopaque: seen in pt with chronic hemolysis, alcoholic cirrhosis
advaned age, and biliary infection
Black-hemolysis
Brown-infection
219
chol increase in tube feeding pt caused by?
| chol stone
CKK decreases, no stimulation from GI
| chol excretion decrease
220
chol stone increase in pregnant women
progesterone->motility decrease in gall bladder
221
biliary colic
after a fatty meal, abdominal pain-->
CCK increase->contraction of ball baldder-->stone move into duct-->pain
if DM patient then no pain
222
air in biliary tract is caused by?
fistula between intestine and gall
| if gall obstruct the ileoceccal valve, air con be seen in biliary tree
223
radionuclide biliary scan is used to ?
diagnose gall stone
| no filling of gall bladder
224
epigastric pain radiating to the back, anorexia and nausea
acute pancreatitis
increase lipase(specifi), amylase
may lead to hypoalcemia by calcium soap deposits on pancreas
pseudo cyst!!!
225
Chronic pancreatitis triad
calcification
steatorrhea
DM
226
Glucoganoma
necrolytic imgratory erythema
| increase Glu, stomatits, cheilosis, abdominal pain
227
pancreatic tumor marker?
CA19-9
| CEA
228
trousseau's syndrome in pancreatic CA
formation & dissolution of clots, 2nd to tumor sensation of PLT aggregation factors
migratory thrombophlebitis-redness and tenderness on palpation ofextremities
treatmen: whipple precedure, chemo, radiation
